Physiotherapy - Theses
Permanent URI for this collection
Search Results
1 - 2 of 2
-
ItemWhat is the influence of adjunctive therapy on outcome following botulinum neurotoxin (BoNTA) injection for focal spasticity in adults with neurological conditions?( 2016)Neurological disorders are the leading cause of disability worldwide. The upper motor neuron syndrome (UMNS) is a common feature of neurological disorders and describes the changes in motor control that can occur in skeletal muscle after an upper motor neuron lesion. Spasticity is one component of the UMNS that leads to a greater degree of motor impairment compared to those not affected by spasticity. The management of focal spasticity is complex and there are a number of clinical indications for which BoNT-A treatment may be prescribed. Patients may be treated for upper or lower limb spasticity, and may have indications related to active/functional ability (i.e., able to walk) or passive/non-functional (i.e., skin integrity, hygiene or pain) outcomes. Botulinum neurotoxin has been established as effective in reducing spasticity in the upper and lower limbs of adults. However, further research is needed to clearly demonstrate whether the reduction in muscle tone translates into improved function. The international consensus statements for the use of BoNT-A treatment in adults suggest that adjunctive therapies should be continued in conjunction with the BoNT-A injection. Despite this recommendation, the evidence for the independent contribution of adjunctive therapies on patient outcomes has not been determined, and limited evidence exists supporting any specific treatment protocols following BoNT-A injection. The aim of this study was to investigate the influence of commonly prescribed adjunctive therapies on goal attainment following BoNT-A injection for focal spasticity in adults with neurological conditions. A group of 31 adults were provided with a prescribed program from an experienced clinician following their BoNT-A injection designed to maximise their outcome. The rate of adherence to the prescribed program was examined after three months to determine if adherence to therapy improved rehabilitation outcomes in terms of goal attainment as measured by the Goal Attainment Scale. The 31 participants had a total of 76 goals. Active indications for treatment made up the majority of the goals (80.3%). Goals were achieved in 43 out of the 76 cases (56.6%; 95% CI = 42.4-69.8%). Therapy adherence was significantly associated with goal attainment (OR = 1.02, p=0.03, 95% CI=1.00 to 1.04). A higher adherence to therapy increased the odds of goal achievement for active indications (OR = 1.03, 95% CI 1.001-1.05, p = 0.01) but not for passive indications. There was no statistically significant interaction between the location of the injection and adherence to the prescribed therapy program on goal attainment (p = 0.28). Overall, active indications for the BoNT-A injection were most reliant on the prescription of adjunctive therapies following BoNT-A injection.
-
ItemFeasibility, safety and efficacy of dance for people with Parkinson's disease: a pilot study( 2013)The purpose of this thesis is to investigate the safety, feasibility and efficacy of dance for people with Parkinson’s disease (PD). Parkinson’s disease is a progressive neurological condition that is characterised by slow gait, reduced movement amplitude, tremor, rigidity, postural instability and diminished health-related quality of life (HRQOL). Physiotherapy and therapeutic exercise aimed at improving gait and balance are argued to be an important component in the management of PD and have been shown to improve gait function, mobility, balance and HRQOL in some individuals. Given the progressive and long term nature of the disease, it is important for people with PD to have access to a wide variety of exercise options so that they can remain active. Recent reports indicate that dance is emerging as an alternative to traditional exercise programs for people with PD, however there is little information regarding the safety and feasibility of dance interventions. A systematic review and critical appraisal was conducted with the aim of identifying studies that provide reports of safety, feasibility, intervention delivery and the efficacy of dance interventions for people with PD. The identified studies were of low to moderate methodological quality and design and the reporting of safety and feasibility outcomes was inconsistent. Whilst attrition was well reported, it was challenging to conclude the level of adherence and the occurrence of adverse events during dance classes due to limited reporting of these outcomes. The level of supervision provided, provision of instructor training and advice and the selection of music and movement choices was also not well reported. The results of a between-group synthesis of balance and mobility data showed a trend towards improvement in these outcomes following a dance intervention when compared to controls. These findings present limited evidence to support the efficacy of dance for people with PD. A group of nine Australians living with mild to moderate PD participated in a pilot case-series study to determine the safety, feasibility and efficacy of a six-week contemporary dance program. Safety and feasibility outcomes evaluated included the occurrence of adverse events, attrition, adherence and participant satisfaction. The effect of the dance program on gait function, functional mobility, balance, balance and gait self-efficacy and HRQOL was examined prior to the intervention, immediately post-intervention and at three months. The contemporary dance program was found to be a feasible and safe activity for people with PD in terms of attrition, adherence and adverse events. Attrition was low, with eight and seven participants completing follow-up assessments at post intervention and three-months respectively. Adherence was high with participants completing 78% of all available dance classes. Significant improvements in gait hypokinesia were observed immediately post-intervention compared to baseline measures and continued to improve three-months later. Significant improvements in functional mobility, relative to baseline were seen at post-intervention with a trend toward improvement noted at three-months. Despite improvements in gait function, there was little to no change observed for measures of balance, gait and balance self-efficacy and HRQOL. These results provide evidence to further support the safety and feasibility of dance for people with mild to moderate PD, and support the need for large randomized controlled trials to determine the efficacy and outcomes of dance therapy. Participant satisfaction is commonly regarded as an important component of quality health care and may influence the successful implementation of new interventions into clinical practice. Two focus groups were conducted after the pilot study with the purpose of gaining insight into the experiences and attitudes of the contemporary dance participants and to explore participant satisfaction within the context of feasibility. Thematic analysis revealed that participants were satisfied with the intervention and considered contemporary dance to be an acceptable form of exercise. The focus groups also revealed that the participants had a strong emotional reaction to the dance classes and identified several emotional, physical and cognitive benefits. This thesis has provided further knowledge to suggest that dance is a safe and feasible exercise alternative for some people with mild to moderate PD. Furthermore, this thesis has provided new evidence to support the efficacy of a short duration contemporary dance program to improve aspects of physical function and HRQOL. Although future work is needed, this research provides clinicians with evidence that supports the implementation of dance into clinical practice where it can benefit individuals living with Parkinson’s disease.